But physicians underestimate role of gastrointestinal side effects

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

BOSTON -- About half of type 2 diabetes patients on glucagon-like peptide-1 (GLP-1) receptor agonists stopped taking them in the first year, and gastrointestinal problems were a major reason for discontinuation, according to researchers here.

Two of the top five reasons that patients listed for quitting the diabetes medication were related to GI problems, but a related survey of physicians found that doctors underestimated the role that GI-related problems played, according to Mirko Sikirica, PharmD, of GlaxoSmithKline (GSK), and colleagues. They presented their findings in a poster presentation at the American Diabetes Association annual meeting.

"This is an interesting and perhaps useful reminder to physicians that patients' perspectives on their treatment and side effects deserve greater recognition and discussion during a consult," said Naveed Sattar, MD, PhD, a professor of medicine at the University of Glasgow in Scotland, in an email to MedPage Today. Sattar was not involved in the study although he did attend the ADA meeting.

"We doctors often focus too much on biochemistry and sometimes forget to ask what our patients feel about their medication satisfaction. We must also do so in an open and genuine manner or else risk patients telling us what we they think we want to hear," he added.

The data were taken from the 2014 Adelphi Diabetes Disease Specific Programme, a survey supported by GSK, that sampled physicians and patients in the U.S. and Europe. More than 800 doctors were interviewed. Out of nearly 11,000 patients, about 2,000 of them had taken or were taking a GLP-1 receptor agonist.

Researchers included an oversample of about 2,500 patients to "ensure sufficient numbers," according to the poster. Of those patients, 452 were reported by the physician to have discontinued a GLP-1 in the last 6 months.

The top five reasons a physician listed for taking a patient off of GLP-1 receptor agonists were:

Lack of blood glucose control: 46%

Nausea/vomiting: 44%

GI side effects: 37%

Patient request: 18%

Lack of patient compliance: 10%

But patients cited GI problems as reasons for discontinuation of GLP-1 receptor agonists:

Made me feel sick: 64%

Made me throw up: 45%

Prefer oral over injection: 40%

Inadequate blood glucose control: 35%

Caused diarrhea/gas/bloating: 26%

The study also looked at the problems experienced by those still taking GLP-1 receptor agonists. Of 750 doctors, 33% though that patients preferred oral medication over injected medication; in reality, 56% did. And 38% of patients on GLP-1 said that the medication "made me feel sick," but only 16% of doctors said that GLP-1 made the patient feel sick.

Sikirica told MedPage Today that it was not clear why physicians underestimate the role of GI problems.

"The data is global, with about eight countries represented, so we can't pull out a single thread," he said, adding that his group plans to submit the study for publication in a peer-reviewed journal.

But his group emphasized in the poster that "understanding patient and physician views may help to improve medication choice and result in more patients remaining on GLP-1 therapy."

In an interview with MedPage Today, Jerome Tolbert, MD, PhD, at Mount Sinai Health System in New York City, said that physicians are generally aware of the potential for GI side effects among patients on a GLP-1 receptor agonist.

"But what may be a problem is when the physician does not discuss this with the patient prior to starting the patient on the medication," said Tolbert, who was not involved in the study. "There may be a problem wherein patients are not well-prepared and get nauseated and then just stop taking it."

He added that he thinks the GLP-1 drugs are improving, and nausea may be less of a problem than it used to be, but some patients may still be unable to tolerate them because of GI problems, which can add to the problem of patients skipping their medications.

Sikirica and a co-author are employees of GSK. Other co-authors are employees of Adelphi Real World.

More in Meeting Coverage

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.